Uterine Tube Encircling Small Bowel Causing Mechanical Obstruction, Case Report and Literature Review

Introduction: Intestinal obstruction is one of the common presentations of patients with acute abdomen to the Surgical Emergency Department, and it is associated with significant morbidity and mortality. The most common causes of acute small bowel obstruction are adhesions and an obstructed hernia. One of the rare causes of acute small bowel obstruction is constriction of bowel wall by fallopian tubes, and it usually occur s secondary to adhesions of previous obstetric and gynecological surgeries. Other gynecological causes include en- dometriosis and Pelvic inflammatory diseases. Case Presentation: We are pre- senting a 56-year-old married female, who is presented with features of acute mechanical intestinal obstruction for duration of two days. She had a history of Caesarian Section, however, no other significant history. CT scan abdomen confirmed the clinical finding and showed closed loop small bowel obstruc- tion with radiological signs of mesenteric ischemia. Diagnostic lap aroscopy was done, and the intraoperative finding was constriction band formed by left tube causing obstruction of ileal loop segment and intestinal obstruction. Dis- cussion: One of the rare causes of mechanical small bowel obstruction is gy- necological causes like endometriosis, internal hernia or like in our case fallo- pian tube adhesions causing a constriction band. The intraoperative decision is challenging and often required skillful laparoscopic surgeon in order to minimize morbidity and preserve the functioning tube.

Small Bowel Obstruction, Fallopian Tubes, Gynecological, Colicky, CT-Scan, Cesarean Section How to cite this paper : Alhassan, M., Bar- gash, A., Al Saadi, H., Al Kahali, A., Al Ma- mari, R. and Ahmed, R. (2026) Uterine Tube Encircling Small Bowel Causing Me- chanical Obstruction, Case Report and Lit- erature Review. Case Reports in Clinical Medicine, 15, 69-74. https://doi.org/10.4236/crcm.2026.153009 Received: August 20, 2025 Accepted: February 25, 2026 Published: February 28, 2026 Copyright © 2026 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access M. Alhassan et al. DOI: 10.4236/crcm.2026.153009 70 Case Reports in Clinical Medicine 1. Introduction Intestinal obstruction is one of the common causes of acute abdominal pain with increased morbidity and mortality. Moreover, the most common causes are adhe- sions and obstructed hernia [1]. Female pelvic organs, including tubes, uterus, and ovaries can cause adhesive obstruction of small bowel specially ileum and distal jejunum. One of the rare causes of acute small bowel obstruction is constriction of bowel wall by fallopian tubes [2]. The causes are usually due to adhesive process following inflammation, infection or prior pelvic surgery [3]. Other gynecological causes include endome- triosis and Pelvic inflammatory diseases [4]. The presentation is usually with car- dinal features of bowel obstruction, especially vomiting and abdominal pain. Diagnosing rare causes of bowel obstruction pre- operatively remains a chal- lenge. Radiological imaging, particularly contrast-enhanced CT, can delineate the site and degree of obstruction but often fails to identify the exact etiology when it involves small pelvic structures such as the uterine adnexa [ 5]. Consequently, many of these conditions are discovered incidentally during surgical exploration, emphasizing the need for maintaining a high index of suspicion for gynecological causes in women of reproductive or postmenopausal age. The morbidity and mortality are usually having a direct relationship with de- layed surgical intervention and diagnosis. We are presenting one of the rare causes of mechanical intestinal obstruction due to encircling of small bowel by fallopian tube causing occlusion of bowel lu- men and mechanical obstruction. 2. Case Presentation A 56-year-old female with past history of Cesarean Section 20 years ago. She presented to the Emergency Department complaining of severe central col- icky abdominal pain, radiated to all over her abdomen , and bilious vomiting for two days. Also, she experienced absolute constipation and abdominal distention for one-day duration. No fever, weight loss or other GI symptoms. No chronic illness, and no previous similar conditions On the examination, she looks dehydrated, afebrile, conscious and oriented. Her BP is 100/70 mmHg , Pulse rate is 110 P/M. Abdominal examination re- vealed, distended abdomen with vague tenderness all over , no palpable mass , bowel sound was exaggerated and rectum was empty on digital rectal examina- tion. Investigations: her WBCs was 13,000, Hb: 10.3 g/dl. RFT & LFT were normal. ABG was normal. Abdomen X-ray revealed dilated small bowel loops with air flu- ids level. CT scan abdomen revealed features of high -grade small bowel obstruc- tion with closed loop obstruction. However, the bowel wall was well enhanced and no radiological evidence of bowel ischemia. Treatment: The patient was admitted for monitoring, and was started on intra- venous hydration, nothing by mouth and nasogastric decompression. Decision M. Alhassan et al. DOI: 10.4236/crcm.2026.153009 71 Case Reports in Clinical Medicine was made for laparoscopic exploration she was taken to Operation theater after resuscitation and written informed consent. The distended bowel obscures the field, thus the decision to convert to open was made. The finding was obstruction at terminal ileum caused by right fallopian tube causing constriction band with mesentery adhesion (Figure 1 ), proximal bowel dilatation with signs of strangu- lation and distal collapsed bowel (Figure 2 ). Adhesions was released and preserved the right uterine tube and small bowel segment. Figure 1 . A band formed by fallopian tube with proximal small bowel obstruction. Figure 2 . Dusky proximal small bowel segment with tube causing constriction ring and adhesions. M. Alhassan et al. DOI: 10.4236/crcm.2026.153009 72 Case Reports in Clinical Medicine 3. Discussion Although there are several causes for acute mechanical small bowel obstruction , the commonest causes among them are adhesions , and obstructed hernia. How- ever, other causes like malignancy (lymphoma, adenocarcinoma), abdominal tu- berculosis and volvulus remain not uncommon [1]. Small bowel obstruction can be caused by adhesive bands, or rarely by fallopian tube encircling the segment of small bowel and forming constricting bands like obstruction [2]. The mechanism of obstruction by the fallopian tube is thought to involve post- operative adhesion of the tube to the bowel mesentery, leading to entrapment or looping of a bowel segment within a fibrous band. Such adhesive processes may develop following prior pelvic surgery, inflammation, or infection, resulting in a constricting mechanism that compromises bowel lumen patency [3]. In the literatures there are a few cases reported for acute intestinal obstruction caused by fallopian tube adhesions and most of the cases occur in middle age group with previous history of surgeries [4]. One of the rare gynecological causes of intestinal obstruction is endometriosis can cause either adhesion of implantation into serosal wall of small bowel with presentation of cardinal features of intestinal obstruction [6]. Very rarely endometriosis can cause large bowel obstruction with complete oc- clusion of rectosigmoid junction [6]. Our patient presented with high grade mechanical small bowel obstruction with complete occlusion of terminal ileum in a patient with a previous history of cesar- ean section which is one of the few cases reported in the literature as a rare cause of mechanical small bowel obstruction. A review of similar cases in the literature highlights the rarity of this condition. For instance, Bugmann et al. and Cameron et al. reported isolated cases where fallopian tubes entrapped bowel segments , resulting in obstruction. These find- ings emphasize the importance of considering gynecological etiologies in women of reproductive or postmenopausal age presenting with unexplained SBO , espe- cially with prior pelvic surgery history [5]. Radiological imaging, particularly CT scan, is invaluable in diagnosing the level and severity of obstruction but may fail to identify the exact etiology when related to small pelvic structures such as the fallopian tubes [7]. The typical features in- clude the “C-loop” or “whirl sign,” which indicate torsion or closed-loop obstruc- tion. However, gynecologic causes are rarely apparent on imaging, and definitive diagnosis often requires diagnostic laparoscopy or laparotomy [7]. Diagnostic laparoscopy has become an essential tool in the assessment of small bowel obstruction, particularly when the etiology is uncertain or when a gyneco- logical cause is suspected [7]. It provides direct visualization of the peritoneal cav- ity, allowing both diagnosis and therapeutic intervention in selected patients [8]. However, in patients with markedly distended bowel loops or dense adhesions, as in the present case, conversion to open surgery may be necessary to prevent iat- M. Alhassan et al. DOI: 10.4236/crcm.2026.153009 73 Case Reports in Clinical Medicine rogenic injury [9]. Timely surgical intervention remains a critical determinant of outcome in pa- tients with mechanical small bowel obstruction [ 10] [11]. Several recent studies have shown that diagnostic and operative delays beyond 24 to 48 hours are asso- ciated with significantly increased rates of bowel ischemia, perforation, sepsis, and mortality [11]. Moreover, delayed intervention often results in higher rates of bowel resection and prolonged recovery, particularly in elderly patients or those with multiple comorbidities. Therefore, maintaining a high index of suspicion and proceeding with early exploration when clinical or radiological findings suggest high-grade obstruction is essential to improving patient survival and minimizing morbidity [12]. 4. Conclusions This case underscores the importance of maintaining a broad differential diagno- sis in women presenting with features of small bowel obstruction , particularly those with a history of cesarean or pelvic surgery. Early surgical intervention may be necessary in certain situations if clear diag- nosis is uncertain , especially for patients with high- grade mechanical intestinal obstruction to decrease morbidity and mortality. One of the rare causes of mechanical bowel obstructions is a gynecological pa- thology like endometriosis and fallopian tube encircling small bowel and requires high index of suspicion. Radiological diagnosis usually failed to identify fallopian tubes as causes of me- chanical bowel obstruction. Surgical release of adhesions and preservation of both small bowel and tubes is a goal to avoid gynecological morbidity and surgical mortality. Conflicts of Interest The authors declare no conflicts of interest regarding the publication of this paper.

[1] Hayanga, A.J., Bass-Wilkins, K. and Bulkley , G.B. (2005) Current Management of Small-Bowel Obstruction. Advances in Surgery, 39, 1-33. https://doi.org/10.1016/j.yasu.2005.05.001 [2] Cameron, M., Janakan, G., Birch, D. and Nazir, S. (2015) A Closed Loop Obstruction Caused by Entrapment of the Fallopian Tube and Herniation through the Broad Lig- ament. International Journal of Surgery Case Reports, 12, 57-59. https://doi.org/10.1016/j.ijscr.2015.02.010 [3] Lam, K. and Lang, E. (2020) Endometriosis as a Rare Cause of Small Bowel Obstruc- tion. ANZ Journal of Surgery, 90, E137-E138. https://doi.org/10.1111/ans.15916 [4] Arafat, S., Alsabek, M.B., Almousa, F. and Kubtan, M.A. (2016) Rare Manifestation of Endometriosis Causing Complete Recto-Sigmoid Obstruction. International Jour- nal of Surgery Case Reports, 26, 30-33. https://doi.org/10.1016/j.ijscr.2016.07.004 [5] ten Broek, R.P.G., Krielen, P., Di Saverio, S., Coccolini, F., Biffl, W.L., Ansaloni, L., et M. Alhassan et al. DOI: 10.4236/crcm.2026.153009 74 Case Reports in Clinical Medicine al. (2018) Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction: 2017 Update of the Evidence -Based Guidelines from the World Society of Emergency Surgery. World Journal of Emergency Surgery, 13, Article No. 24. https://doi.org/10.1186/s13017-018-0185-2 [6] Sippola, S., Sallinen, V., Scheinin, T., et al. (2021) Delayed Surgery Increases Morbid- ity and Mortality in Adhesive Small Bowel Obstruction: A Population -Based Study. British Journal of Surgery, 108, 442-448. [7] Bugmann, P., Hanquinet, S., Brundler, M.A., Birraux, J., Genin, B. and Le Coultre, C. (2001) Intestinal Obstruction Caused by an Ectopic Fallopian Tube in a Child: Case Report and Literature Review. Journal of Pediatric Surgery, 36, 508-510. https://doi.org/10.1053/jpsu.2001.21630 [8] Amara, Y., Leppaniemi, A., Catena, F., Ansaloni, L., Sugrue, M., Fraga, G.P., et al. (2021) Diagnosis and Management of Small Bowel Obstruction in Virgin Abdomen: A WSES Position Paper. World Journal of Emergency Surgery, 16, Article No. 36. https://doi.org/10.1186/s13017-021-00379-8 [9] Di Saverio, S. and Coccolini, F. (2018) Laparoscopic Adhesiolysis in Small Bowel Ob- struction: Indications , Technique, and Outcomes. Surgical Endoscopy , 32, 2220- 2231. [10] Di Saverio, S., Podda, M., De Simone, B., et al. (2023) WSES Guidelines for the Man- agement of Small Bowel Obstruction. World Journal of Emergency Surgery, 18, Ar- ticle No. 14. [11] Sallinen, V., Di Saverio, S., Haukijärvi, E., et al. (2020) Laparoscopic versus Open Adhesiolysis for Small Bowel Obstruction— A Multicenter, Prospective, Randomized Trial. Annals of Surgery, 271, 1081-1088. [12] Loftus, T.J., Efron, P.A., Bala, T.M., et al. (2019) Timing of Surgical Intervention for Small Bowel Obstruction: An American College of Surgeons NSQIP Analysis. Journal of Trauma and Acute Care Surgery, 87, 144-153.